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The combined effects of grain digestibility and dietary fibre on digesta passage rate and satiety in humans are poorly understood. Satiety can be increased through gastric distention, reduced gastric emptying rate and when partially digested nutrients reach the terminal ileum to stimulate peptide release through the ileal/colonic brakes to slow the rate of digesta passage. This study determined the effects of grain digestibility and insoluble fibre on mean retention time (MRT) of digesta from mouth-to-ileum, feed intake (FI), starch digestion to the terminal ileum and faecal short chain fatty acids (SCFA) in a pig model. Twelve grain-based [milled sorghum (MS), steam-flaked-sorghum, milled wheat, and steam-flaked-wheat (SFW)] diets with different intrinsic rates of starch digestion, assessed by apparent amylase diffusion coefficient (ADC), and fibre from oat hulls (OH) at 0, 5 and 20% of the diet were fed to ileal-cannulated pigs. MRT was affected by grain-type/processing (P

Introduction Functional dyspepsia (FD) is a prevalent condition with multifactorial pathophysiology, including impaired gastric accommodation (GA), hypersensitivity to gastric distention, and delayed gastric emptying. Drink tests (DT) have been proposed as a potential biomarker for the presence and severity of gastric sensorimotor dysfunction. Thus, we aimed to summarize the state of knowledge on different DT and their potential as a biomarker for FD. Methods A PubMed and MEDLINE search was conducted for English language articles, reviews, meta-analyses, case series, and randomized controlled trials, including also published meeting abstracts. Results Several DT have been described in literature (e.g., different type of liquid, number of calories used, pace of drinking, and subject's awareness of the amount of liquid drunk). FD patients ingest significantly less volume in the different variants of the tests. The slow nutrient ("satiety drinking") test (SDT) studies show the most consistent separation between health and FD and correlation with GA. However, sensitivity to distention may be correlated with rapid DT. SDTs were used to evaluate the effect of several pharmacological agents, often showing concordance between their effects on GA and tolerated nutrient volume. This correlation was not found mainly for agents with central actions. Discussion An SDT is a potential diagnostic biomarker in FD, reflecting GA. Additional studies are required to confirm its role as a predictive biomarker for treatment outcome in FD.

Chronic massive gastric distention is a rare condition that can occur due to an underlying obstruction or dysmotility. Gastric outlet obstruction (GOO) is often the culprit that can manifest as the result of the luminal, mural, or extrinsic compression. Gastric adenocarcinoma can rarely manifest as massive gastric distention due to partially obstructing mass or peptic stricture. Severe and fatal sequelae may develop, if early detection and appropriate intervention are delayed, such as gastric decompression, endoscopic evaluation and/or surgical resection. Herein, we present a case of a 60-year-old male who presented with progressive worsening of nonspecific symptoms over the 8-month period. He was found to have remarkable massive gastric distention on imaging which was chronic in etiology secondary to GOO due to metastatic signet-ring cell gastric adenocarcinoma.

ST-segment elevation myocardial infarction (STEMI) is the most serious manifestation of acute coronary syndrome. A variety of noncardiac conditions can mimic STEMI on electrocardiography (ECG). We describe a case of gastrointestinal distention and ileus masquerading as STEMI on ECG and posits a mechanism for this effect. (Level of Difficulty: Intermediate.), Central Illustration, ST-segment elevation myocardial infarction (STEMI) is the most serious manifestation of acute coronary syndrome. A variety of noncardiac conditions…

Highlights • Rett syndrome is associated with pathologic aerophagia. • Rett syndrome associated aerophagia can lead to gastric perforation. • Sarcina ventriculi colonization is also a risk factor for gastric perforation. • It is unknown how Sarcina ventricula colonization and Rett syndrome interact as risk factors for gastric perforation., Here we describe a case of a 15-year-old child with Rett syndrome who presented with extreme gastric distension and fatal perforation in the setting of long-standing aerophagia and pathologic colonization with Sarcina ventriculi, a rare bacteria implicated in gastric perforation. This is the first report of gastric perforation associated with colonization by Sarcina in a patient with pathologic aerophagia. Gastric colonization with Sarcina should be considered in intellectually disabled children with pathologic air swallowing who present with severe gastric dilation and/or perforation.

Gastric outlet obstruction (GOO) is a rare diagnosis that can be challenging to make as its symptoms, which include abdominal distention, nausea, and persistent vomiting, often overlap with many other acute abdominal pathologies. Point-of-care ultrasound (POCUS) can help the clinician identify gastric outlet obstruction in patients who present to the emergency department (ED). Sonographic identifiers include a markedly dilated stomach that is filled with both hyper- and hypoechoic contents and may extend into the lower abdomen in the pelvic views.

An 8-month-old spayed female ferret (Mustela putorius furo) was presented for evaluation of persistent, severe gastric distention following gastrotomy to retrieve several foreign bodies. A structural cause of gastric outflow obstruction was not identified ultrasonographically or surgically. A 14 Fr gastrostomy and an 8 Fr jejunostomy tube were used to facilitate medical management of severe gastric stasis and to allow enteral nutrition. The ferret tolerated the feeding tubes well and recovered completely following intensive medical therapy. This report describes successful management of idiopathic gastric distention using gastric and jejunal feeding tubes in a ferret. Feeding tubes and supplemental nutrition plans should be considered for management of ferrets with compatible disease processes.

The laryngeal mask airway, it is a supraglottic airway instrument developed by British Anesthesiologist Dr. Archie Brain. Initially it was designed only for the use in the operating room for the purpose of elective ventilation; it is a proved alternative to bag-valve-mask ventilation, freeing the hands of the provider with the benefit of less gastric distention. Initially used primarily in the operating room setting, the laryngeal mask airway has more recently come into use in the emergency situation as a very important device for the treatment of the difficult airway. The objective of the study was To compare the various parameters that occur during laryngeal mask airway insertion and endotracheal intubation for surgical procedures under general anesthesia. In the present study, 18 children’s belongs to age group of 2 to 6 years and 32 children’s belongs to age group of 7 to 10 years. Totally 29 children’s were male and 21 children’s were female. In LMA group, LMA insertion was graded easy in 97% of patient and difficult in 3% cases. In none of the case was LMA insertion impossible (0%). In the ETT group, endotracheal intubation was easy in 85% of patients and difficult in 15% of patients. In none of the patients was endotracheal intubation impossible. In the LMA group, LMA was placed correctly in the first attempt in 94% patients and was placed correctly in the 2nd attempt in 6%. The ETT was placed in the first attempt in 80% patients and was placed correctly in the 2nd attempt in 20%. According to the results of our study, laryngeal mask airway it is device of choice for elective outpatient surgeries in pediatric patients due to its lesser hemodynamic changes and complications, ease of insertion in cases where endotracheal tube insertion gets difficult and also faster insertion.

OBJECTIVE To investigate the effects of respiratory phase, body position, beam center location, and gastric distention on radiographic assessment of liver size in dogs. ANIMALS 12 Beagles. PROCEDURES Liver length and the ratio of liver length to T11 length were determined on lateral radiographic views obtained with various techniques. Images were acquired at maximal expiration or maximal inspiration, with dogs in right or left recumbency, with the beam centered on the caudal border of the scapula or the 13th rib, and after food was withheld or with gastric distention. Effects on organs adjacent to the liver were assessed with CT. Changes of the thoracic cavity during the respiratory cycle were investigated with fluoroscopy. RESULTS Liver length was significantly greater on radiographs obtained at maximal expiration than at maximal inspiration, but there was no increase in the ratio of liver length to T11 length. Body position, beam center location, and gastric distention did not significantly affect liver size. For CT, location of the spleen and stomach and location or size of the liver did not change markedly between right and left recumbency. Fluoroscopy revealed that thoracic width was less at maximal expiration than maximal inspiration. CONCLUSIONS AND CLINICAL RELEVANCE Liver length was greater at maximal expiration than at maximal inspiration because of a smaller thoracic width. Body position, beam center location, and gastric distention did not affect liver length. The ratio of liver length to T11 length was not significantly affected by any of the factors investigated.

Heterotopic pancreas is a silent gastrointestinal malformation that may become clinically evident when complicated by inflammation and pseudocyst formation. We report a 26 year-old male presenting with vomiting, pain and abdominal distention. An abdominal CT scan showed an important gastric distention secondary to a 4-cm cystic lesion located in the antrum wall. An endosonography showed that the lesion obstructed the gastric outlet and was compatible with a pseudocyst. A cysto-gastrostomy was performed draining the cyst. Its high lipase and amylase content confirmed that it was a pancreatic pseudocyst. Six months later, the lesion appeared again and a subtotal gastrectomy was performed Histopathology confirmed ectopic pancreatic tissue.

Introduction Although the important roles of bidirectional interactions between the brain and gut in stress and emotional responses have long been recognized, the underlying neuronal mechanisms remain unclear. The bed nucleus of the stria terminalis (BNST) is a limbic structure involved in stress responses and negative affective states, such as anxiety and depression. We have previously demonstrated that noradrenergic transmission within the ventral part of the BNST (vBNST) plays a crucial role in anxiety‐like behaviors and pain‐induced aversion. Objectives This study aimed to examine the involvement of noradrenergic transmission via β‐adrenoceptors within the vBNST in bidirectional brain‐gut interactions. Methods We measured the gastric distention (GD)‐induced noradrenaline release within the vBNST of freely moving rats using an in vivo microdialysis technique. Gastric emptying and intestinal transit were examined following intra‐vBNST injections of isoproterenol, a β‐adrenoceptor agonist, in the absence or presence of the coadministration of timolol, a β‐adrenoceptor antagonist. Results Gastric distention at a higher pressure (45 mm Hg) but not at a lower pressure (25 mm Hg) resulted in a significant increase in extracellular noradrenaline levels within the vBNST. Intra‐vBNST injections of isoproterenol (30 nmol/side) induced significant reductions in gastric emptying and small intestinal transit, both of which were reversed by the coadministration of timolol (30 nmol/side). Conclusion Noradrenergic transmission via β‐adrenoceptors within the vBNST was involved in bidirectional brain‐gut interactions. These findings suggest that gastric dysfunction may induce negative affective states via the enhanced release of noradrenaline within the vBNST which, in turn, may cause gastrointestinal impairments., In vivo microdialysis experiments demonstrated that gastric distention induced an increase in noradrenaline release within the vBNST. Intra‐vBNST injections of isoproterenol, a β‐adrenoceptor agonist, reduced gastric emptying and small intestinal transit, and these reducing effects were reversed by the coadministration of timolol, a β‐adrenoceptor antagonist. The present findings demonstrated important roles of noradrenergic transmission via β‐adrenoceptors within the vBNST in the bidirectional brain‐gut interactions.

An approximately four-year-old male castrated guinea pig (Cavia porcellus) was presented for painful defecation with a 24-hour history of hyporexia and intermittent episodes of rolling behavior. Upon presentation the patient was quiet, alert, and responsive, and mildly hypothermic. Abdominal palpation revealed an approximately 2-cm long oblong mass within the caudal abdomen. Abdominal radiographs revealed gastric dilation without volvulus and a peritoneal mass effect. The patient was euthanized following gastric reflux of brown malodorous fluid from his nares and oral cavity. A necropsy was performed and revealed a jejuno-jejunal intussusception causing mechanical gastrointestinal ileus, and gastric dilatation without volvulus. While non-obstructive gastrointestinal stasis is common and obstructive ileus is uncommon in guinea pigs, this report shows that intestinal intussusception is a differential in guinea pigs with ileus and gastric dilatation.Keywords: Bloat, Colic, Gastric distention, Gastrointestinal tract, Rodent

The motivation to seek and consume water is an essential component of human fluid–electrolyte homeostasis, optimal function, and health. This review describes the evolution of concepts regarding thirst and drinking behavior, made possible by magnetic resonance imaging, animal models, and novel laboratory techniques. The earliest thirst paradigms focused on single factors such as dry mouth and loss of water from tissues. By the end of the 19th century, physiologists proposed a thirst center in the brain that was verified in animals 60 years later. During the early- and mid-1900s, the influences of gastric distention, neuroendocrine responses, circulatory properties (i.e., blood pressure, volume, concentration), and the distinct effects of intracellular dehydration and extracellular hypovolemia were recognized. The majority of these studies relied on animal models and laboratory methods such as microinjection or lesioning/oblation of specific brain loci. Following a quarter century (1994–2019) of human brain imaging, current research focuses on networks of networks, with thirst and satiety conceived as hemispheric waves of neuronal activations that traverse the brain in milliseconds. Novel technologies such as chemogenetics, optogenetics, and neuropixel microelectrode arrays reveal the dynamic complexity of human thirst, as well as the roles of motivation and learning in drinking behavior.

Background The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the second most performed bariatric surgical procedure. With the increasing number of patients undergoing bariatric surgery, the number of complications is also growing. Early diagnosis and treatment of the complications is crucial. Case presentation A very unusual complication was met after an uneventful laparoscopic gastric bypass (LGBP) procedure due to an obstructing blood clot in the biliairy limb resulting in an acute pancreatitis and gastric distention, accompanied by an obstructing blood clot in the distal ileum causing small bowel obstruction. A review of the occurrence of these complications and the diagnosis and treatment is presented. Conclusion Post-bariatric acute pancreatitis is uncommon, but could be fatal. Blood clots should be considered as possible causes of small bowel obstruction, ileus or pancreatitis.

Computed tomography showed new, severe gastric distention. A scan 11 months previously had been normal.

A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. Computed tomography revealed marked gastric distention containing large amount of residual food debris. Endoscopic retrieval was unsuccessful. Surgical removal of the foreign bodies was done. The patient did well and was discharged from the hospital.

Electroacupuncture (EA) point specific (ST36-37) stimulation decreases cardiovascular reflex responses through supraspinal regions such as the hypothalamic paraventricular nucleus (PVN) while mechanical stimulation of acupoints decreases pressor responses through peripheral thermal transient receptor potential vanilloid type-1 (TRPV1). Moxibustion generating heat applied at acupoint in combination with antihypertensive drugs decreases elevated blood pressure. We hypothesized that moxibustion modulates sympathoexcitatory cardiovascular responses through the hypothalamic PVN and peripheral heat sensitive TRPV1 in the absence of antihypertensive drugs. Rats were anesthetized, ventilated, and heart rate and mean blood pressure were monitored. Gastric distention induced consistent pressor reflex responses every 10-min. Thirty-minutes of bilateral moxibustion at the acupoint ST36, overlying the deep peroneal nerves, reduced the gastric distention evoked elevation in blood pressure. Blood pressure reflex responses were not reduced by both EA and moxibustion at G39. The moxibustion inhibition but not EA inhibition of the cardiovascular responses was reversed with blockade of local heat sensitive TRPV1 at ST36. Accordingly, activation of thermal TRPV1 by moxibustion at an average of 44.2°C in contrast to 40°C reduced the pressor responses. Naloxone, an opioid receptor antagonist, microinjected into PVN inhibited transiently the effect of moxibustion. Thus, activation of peripheral heat sensitive TRPV1 mediated the moxibustion-inhibition, but not EA-inhibition, of sympathoexcitatory cardiovascular reflex responses through hypothalamic PVN opioid system.

Background: Gastric distention contributes to meal termination. There is little research on the neural correlates of gastric distention by food. To date, neural measures have not been obtained concurrently with measurements of gastric distention.Objectives: 1) To study how offering a small versus a large water load following a standardized nutrient load affects gastric distention over time. 2) To assess associations between satiety experiences and brain activity and the degree of gastric distention.Method: 19 healthy males (age 22.2 +/- 2.5 y, BMI 21.8 +/- 1.5 kg/m(2)) participated in a randomized crossover study with two treatments: ingestion of a 500-kcal 150-mL liquid meal shake followed by a low (LV, 50 mL) or a high volume (HV, 350 mL) water load. At baseline and three times after ingestion satiety was scored, MRI scans were made to determine total gastric content volume (TGV) and functional MRI scans were made to measure cerebral blood flow (CBF).Results: TGV was significantly higher for HV compared to LV at all time points (p < 0.001) with relative differences between HV and LV of 292 +/- 37 mL after ingestion, 182 +/- 83 mL at t = 15 min and 62 +/- 57 mL at t = 35 min. Hunger decreased (p = 0.023) and fullness increased (p = 0.030) significantly more for HV compared to LV. Ingestion increased CBF in the inferior frontal gyrus and the anterior insula, but there were no differences between treatments. There were no significant correlations between appetite ratings and CBF values.Conclusion: Performing concurrent gastric MRI and CBF measurements can be used to investigate neural correlates of gastric distention. Increased distention did not induce significantly greater brain activation. Future research should further examine the role of the inferior frontal gyrus in satiety.

Functional dyspepsia (FD), a disorder thought to originate from the gastroduodenum, is one of the most prevalent functional gastrointestinal disorders. In this review, we focused on gastroduodenal mechanisms involved in the pathophysiology of FD. The roles of impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention and to luminal agents, altered mucosal integrity, low-grade inflammation and psychological stress are reviewed. The underlying pathophysiology in FD is probably multifactorial, involving a combination of several of these factors, ultimately leading to symptom pattern and severity.

Background The recent identification of sweet taste receptors in the gastrointestinal tract has important implications in the control of food intake and glucose homeostasis. Lactisole can inhibit the sweet taste receptor T1R2/T1R3. Aim/Methods The objective was to use lactisole as a probe to investigate the physiological role of T1R2/T1R3 by assessing the effect of T1R2/T1R3 blockade on GLP 1 PYY and CCK release in response to 1) intragastric administration of nutrients or 2) intraduodenal perfusion of nutrients. The study was performed as a randomized double blind placebo controlled crossover study that included 35 healthy subjects. In part I subjects received intragastrically 75 g of glucose in 300 ml of water or 500 ml of a mixed liquid meal with or without lactisole. In part II subjects received an intraduodenal perfusion of glucose (29.3 g glucose/100 ml; rate: 2.5 ml/min for 180 min) or a mixed liquid meal (same rate) with or without lactisole. Results The results were that 1) lactisole induced a significant reduction in GLP 1 and PYY but not CCK secretion in both the intragastric and the intraduodenal glucose stimulated parts (P = 0.05) 2) comparison of the inhibitory effect of lactisole showed a significantly greater suppression of the hormone response in the intragastric part (P = 0.023) and 3) lactisole had no effect on liquid meal stimulated parameters. Conclusion We conclude that T1R2/T1R3 is involved in glucose dependent secretion of satiation peptides. However the results of the liquid meal stimulated parts show that the receptor alone is not responsible for peptide secretion.

The aim of this study was to investigate the effects and mechanisms of gastric electrical stimulation (GES) on proximal stomach distention-induced visceral sensitivity. Isobaric gastric distention was performed using a barostat system in 8 normal and 6 vagotomized dogs and animal behaviors were noted and graded. The normal dogs were studied in 4 sessions: control (no GES), short pulse GES, long pulse GES, and dual-pulse GES, and the vagotomized dogs were studied in three sessions: control (no GES), long pulse GES and guanethidine. It was found that: 1) proximal stomach distention-induced behavioral changes were mediated by vagal and sympathetic pathways. The total behavior score (TBS) was 40.6 ± 7.4 in the controls, 15.3 ± 8.9 in vagotomized dogs (P=0.006 vs. control) and 8.8 ± 0.9 in the vagotomized dogs with guanethidine (P=0.04 vs. vagotomy). The behavioral changes were mediated via the vagal pathway at distention pressures below 20 mmHg, but mediated via both the vagal and sympathetic pathways at distention pressures equal to and above 20 mmHg. 2) GES with long pulses or dual pulses but not short pulses reduced the distention-induced behavioral score (P=0.003, P=0.006 and P=0.7, respectively) and the effects of GES of long pulses might be mediated via the vagal and sympathetic pathways. In conclusion, gastric distention-induced visceral sensitivity is mediated via the vagal pathway at low distention pressures but via both vagal and sympathetic pathways at high distention pressures. GES with long but not short pulses reduces distention-induced visceral sensitivity.

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups that are caused by gastric distention, spicy foods and neural dysfunction can resolve themselves without any treatment. Some hiccups are associated with certain diseases or they occur postsurgically, and life-restricting intractable hiccups should be treated. The cause of hiccups should be quickly determined so as to administer the proper treatment. Hiccups often remit spontaneously within a short period of time, but they may also occur without remission for a prolonged period in some cases. We report here on a 36-year-old man who suffered with intractable hiccups for 5 years. We administered a single oral dose of baclofen, and then the hiccups disappeared. We conclude that a single dose of baclofen is a good treatment for intractable hiccups.

The mechanical and secretory factors in the stomach that may be implicated in the production of symptoms are still poorly understood. To determine whether symptoms in response to postcibal gastric distention are associated with increased acid secretion, the relationship between symptoms, acid secretion and intragastric pressure in healthy subjects was investigated. Perception (by a 0–6 score questionnaire) and the gastric secretory response to a glucose test meal (by intragastric titration) was quantified either at low (2 mmHg) or at high (8 mmHg) intragastric pressure levels, maintained by feedback regulation of the air volume within a gastric bag using an electronic barostat. Low intragastric pressure produced a small gastric expansion (87 ± 26 ml; mean ± SE) that was largely unperceived (score 0.7 ± 0.5). High intragastric pressure did not increase acid secretion (15 ± 3 mEq h-1 vs 16 ± 3 mEq h-1 at low pressure), but produced symptomatic perception (score 2.5 ± 0.7) related to a marked gastric expansion (521 ± 92 ml; P < 0.05 vs low pressure for both). It was concluded that postcibal gastric hypertension induces symptoms without affecting the gastric acid secretory response to the meal.

The hypertrophic pyloric stenosis (HPS) is not a rare condition due to a lack of relaxation of the pyloric muscle caused by hypertrophy and hyperplasia of the antropyloric muscular ring. HPS is the most common surgical cause of vomiting in infants, and it is a very frequent cause of access in emergency hospital.

Summary Dietary fibres have different physiological effects and provide a variety of health benefits, including satiety. They are thought to impact on satiation (the satisfaction of appetite during feeding that marks the end of eating and satiety (inhibition of hunger as a result of having eaten), because of their properties of adding bulk (satiation) and producing viscosity (satiety). Pre-absorptive factors, such as gastric distention, and the work and time required for chewing are important for satiation. For this reason, the bulking and textural properties of fibre make it an attractive ingredient for enhancing satiation. Adding bulk to the diet with fibre will also reduce the energy density of the diet. Satiety signals are generated both pre- and post-absorptively. Viscous soluble fibres may be useful because they prolong the intestinal phase of nutrient digestion and absorption. This means that there is a longer time over which the macronutrients can interact with the pre-absorptive mechanisms of satiation and satiety, as well as prolong the time course of post-absorptive signals. Diets low in energy and fat, such as those typically recommended for obese people, are poorly satiating. Adding fibre to low-calorie/low-fat foods may enhance satiety, but because weight-loss meals are low in energy and fat, satiety is likely to be short lasting. Not all dietary fibre has an impact on satiety. We review types of dietary fibre, whole foods that contain dietary fibre, and published studies on the effect of these fibres on satiety.

It is theorized that repeated gastric distention leads to dilatation of the cardia and the development of GERD. We hypothesize that cardia circumference correlates with the presence and the severity of GERD, and we developed software to measure cardia circumference from static endoscopic images. Our aims were to validate the software and to quantify cardia circumference along the spectrum of GERD.Software-based measurements were compared with actual measurements in animal and mechanical models. A retrospective review of an endoscopic database and patient charts produced 273 subjects, grouped as follows: controls, GERD,or = 3-cm Barrett's esophagus, or3-cm Barrett's esophagus. A blinded abstractor measured cardia circumference by using images from the database.Software and actual measurements correlated closely and were reproducible among observers. Median cardia circumference for each group was the following: control, 31.8 mm; GERD, 37.8 mm;or = 3-cm Barrett's esophagus, 38.4 mm; and3-cm Barrett's esophagus, 45.0 mm (p0.001). By using 34.3 mm as a cutoff, cardia circumference was 85.3% sensitive and 89.6% specific for the diagnosis of GERD.There was a direct relationship between cardia circumference and the presence of GERD. This finding augments our understanding of the anatomic contributions of the esophagogastric junction in the pathogenesis of GERD. Cardia measurement may prove to be a useful diagnostic tool.

OBJECTIVE. We hypothesized that performing CT gastrography with the patient in the left posterior oblique (LPO) position would provide better distention and less residual fluid for the lower part of the stomach than CT gastrography with the patient in the standard supine position.CONCLUSION. The LPO position for CT guaranteed the distensibility of and minimal residual fluid in the lower part of the stomach, thus resulting in excellent 3D CT gastrographic images.

Objective: To introduce the notion of noninvasive mechanical ventilation as an alternative for invasive ventilation in children, describing advantages and disadvantages, indications, and the process of equipment installation. Sources of data: Literature review through PubMed/Medline, using as source articles focusing on noninvasive ventilation in pediatric populations, as well as consensus statements and metanalyses concerning noninvasive ventilation in adults. Summary of the findings: The main indication for noninvasive ventilation is respiratory failure due to hypercapnia. It is contra-indicated in the presence of hemodynamic instability. The advantages of noninvasive ventilation include: the equipment is easy to install; it is not invasive and involves less discomfort; there is a lower incidence of complications associated with the endotracheal tube; lower cost. The disadvantages are: gastric distention; transient hypoxemia; facial skin necrosis. The equipment required for noninvasive ventilation includes an interface (mask) and a respirator. The removal of noninvasive ventilation equipment is relatively simple, but chronic patients may require assistance in the home. Conclusions: Noninvasive ventilation is a less costly, efficient and simple to perform alternative in cases of respiratory failure without hemodynamic instability.

Summary The LMA has gained widespread popularity, and gives the clinician a new approach to providing anesthesia for both adults and children in a wide variety of clinical situations. This device most definitely represents one of the major advances in ambulatory anesthesia within the last decade. The LMA is extensively used for outpatient surgical procedures because it is easy to use, allows rapid induction and early emergence from anesthesia, and thus improves perioperative efficiency. However, it is important to recognize the limitations of the LMA and adhere to the contraindications for its use. Proper selection of patients and learning the correct insertion technique are necessary before the use of the LMA. Maintenance of adequate depth of anesthesia should prevent most of the common problems associated with the LMA, such as difficulty in placement, difficult ventilation, gastric distention, coughing, and laryngospasm. Monitoring for gastric distention may help in preventing regurgitation of gastric contents. With increasing experience and evidence of its safety, the use of the LMA may be expanded to a wider variety of clinical situations.

Endoscopy of the stomach is performed so routinely and with acceptable results that there are few requests for detailed radiologic examination, predominantly after bariatric or hiatus hernia surgery. Nevertheless, computed tomographic (CT) examination with 3-dimensional (3D) virtual gastroscopy may provide additional and complementary information useful in therapeutic decision making, and it also offers an alternative gastric examination for patients in whom conventional endoscopy is not straightforward. Abdominal CT is usually performed without gastric distention. However, double-contrast barium meals and enemas, enteroclysis, CTof the colon, and CT enterography of the small intestine have all shown that distention of the alimentary tract is critical for demonstration of mucosal pathology. Horton and Fishman [1] suggested the use of water for gastric distention. Springer et al [2] obtained the best results with air contrast but found 3D spatial resolution to be limited by computer performance and software constraints at that time. More recently, with the advent of rapid 3D applications, some investigators have evaluated CT 3D gastric imaging, with and without 2-dimensional (2D) imaging, and described promising results for characterizing advanced gastric cancer [3], gastrointestinal stromal tumours (GIST) [4], and moderate results for early gastric cancer [4e6]. In this technical note, we present one approach to 3D CT examination of the stomach.

The hiccup reflex arc involving the brainstem, phrenic and vagus nerves, and the sympathetic chain is associated with singultus. There are many possible organic, psychogenic, idiopathic, and iatrogenic instigators. We describe a case of singultus in a 69-year-old man secondary to his CPAP mask, with resolution after he stopped using the mask. Our case establishes that CPAP may be a cause of iatrogenic aerophagia leading to gastric distention, singultus, and emesis and highlights the importance of a complete history.

A structurally intact and competent lower esophageal sphincter in the experimental model shortens and becomes incompetent during gastric distention. The aim of this study was to evaluate postprandial reflux as an indirect measure of this volume-induced sphincter shortening and incompetency. Reflux (pH4) in the 2-hour period following a meal was retrospectively analyzed from the 24-hour esophageal pH recordings of 94 healthy volunteers and 609 symptomatic patients. Forty-six percent of patients had pathologic postprandial reflux (95th percentile of normal). The prevalence was lower in patients with a structurally intact compared to a defective lower esophageal sphincter (32% vs. 58%; P0.001). Pathologic postprandial reflux was greater in patients with abnormal compared to normal findings on 24-hour pH study (76% vs. 21%; P0.001). Patients with a normal 24-hour pH study and postprandial reflux had shorter sphincter lengths (2.33 vs. 2.82 cm; P0.001) and lower pressures (10.78 vs. 14.24 mm Hg; P0.005). A hiatal hernia increased the prevalence of postprandial reflux (P0.001) in all patients (67% vs. 38%) and in the subgroup with a structurally intact sphincter (75% vs. 27%, P0.001). Postprandial reflux is a dynamic indicator of sphincter competency, and increases as the structural sphincter characteristics deteriorate and is augmented by a hiatal hernia.

The aim of this study was to observe the effect of electroacupuncture (EA) at the ST36 acupoint on the firing rate of gastric-related neurons in the spinal dorsal horn (SDH) and nucleus tractus solitarius (NTS). There were different effects of gastric distention in SDH and NTS in 46 male Sprague-Dawley rats. In 10 excitatory neurons in SDH, most of the neurons were inhibited by homolateral EA. The firing rates decreased significantly (P<0.05) in 10 excitatory gastric-related neurons in NTS; the firing rates of 6 neurons were further excited by homolateral EA, with a significant increase of the firing rates (P<0.05); all inhibitory gastric-related neurons in NTS were excited by EA. The inhibition rate of homolateral EA was significantly increased in comparison with contralateral EA in gastric-related neurons of SDH (P<0.05). There was no significant difference between homolateral and contralateral EA in gastric-related neurons of NTS. EA at ST36 changes the firing rate of gastric-related neurons in SDH and NTS. However, there are some differences in responsive mode in these neurons. The existence of these differences could be one of the physiological foundations of diversity and complexity in EA effects.

An adolescent male trauma patient developed new asymptomatic ST segment elevations that mimicked a myocardial infarction on infero-lateral telemetry leads on hospital day #8, following burn excision and skin grafting. This was confirmed on 12 lead electrocardiogram. Laboratory test results indicated normal potassium. Troponins ×3 were negative. X-rays indicated marked gaseous gastric distention. A nasogastric tube was placed with evacuation of 400mL of fluid and resolution of gastric distention. After gastric decompression, the ST segment elevations resolved. This case illustrates the need to consider acute gastric distention in the differential of acute ST segment elevation. Learning objective : Electrocardiographic ST segment elevation generally indicates myocardial infarction. However, in the asymptomatic patient with normal troponins, alternative explanations, such as gastric distention should be considered.>

Background: Treatment of gastrointestinal symptoms in patients with systemic sclerosis has been a challenge for years. Drugs, immunosuppressive or anti-fibrotic have always been associated with complications. The effectiveness of probiotics as live microorganisms of nonpathogenic always was to treat the symptoms.Methods:In this clinical trial, 37 patients with systemic sclerosis with mild to severe symptoms in the intervention and control groups were studied. Inventory (UCLA SCTC GIT 2.0) was used for rating the severity of the gastrointestinal tract. Collected data was analysed by statistical methods using SPSS.19.Results: Improvement was seen in total score after the use of probiotics in gastrointestinal reflux condition ((P=0.001), gastric distention (P =0.001), emotional function ((P=0.001), social.Conclusions:This study showed that probiotics were significantly effective in treatment of gastrointestinal symptoms in patients with systemic sclerosis.

Plasma ghrelin levels are rapidly suppressed by ingestion or gastric delivery of nutrients. Given that the majority of circulating ghrelin appears to be of gastric origin, we addressed the contribution of gastric distention or nutrient sensitivity to this response. Awake, unrestrained rats received intragastric infusions of glucose or water (1 ml/min for 12 min) with gastric emptying either proceeding normally or prevented by inflation of a pyloric cuff. When emptying was permitted, glucose infusion reduced ghrelin level by approximately 50%, and, in agreement with previous data, water infusions were without effect. Ghrelin level was not affected by either infusate when gastric emptying was prevented, thereby discounting a role for gastric distention in the meal-related ghrelin response. That glucose and water infusions were similarly ineffective when the pylorus was occluded shows, further, that gastric chemosensation is not a sufficient trigger for the ghrelin response. We conclude that the meal-related suppression of plasma ghrelin requires postgastric (pre- or postabsorptive) stimulation.

Objective—To determine the usefulness of pneumoesophagography, compared with that of survey radiography, for characterization of esophageal pathological changes in dogs with endoscopically confirmed intraluminal Spirocerca lupi nodules in the caudal portion of the esophagus. Design—Diagnostic test evaluation. Animals—30 dogs with endoscopically confirmed spirocercosis. Procedures—Dorsoventral (DV) and right lateral recumbent (RLR) thoracic survey radiographs were obtained for each dog. Endoscopy was subsequently performed, the esophagus was inflated with air, and left lateral recumbent, RLR, DV, and ventrodorsal thoracic radiographs were obtained. The amount of esophageal and gastric distention was recorded. Visibility, location, and surface characteristics of lesions and total length of esophageal involvement were recorded independently for each radiograph and modality and compared with each other. Results—Survey DV radiographs were more reliable than survey RLR radiographs for detecting caudal esophageal pathological changes. Lateral pneumoesophagograms showed more esophageal air and had more visible nodules than did their orthogonal counterparts. Right lateral recumbent pneumoesophagograms allowed for evaluation of the air-filled stomach, particularly the cardiac portion, for additional pathological changes. Pneumoesophagography allowed the mural position (47% located dorsally) and surface characteristics of Spirocerca nodules to be determined. Six of 9 dogs with confirmed malignant disease had an irregular nodule surface suggestive of neoplastic transformation. Conclusions and Clinical Relevance—Pneumoesophagography was easily performed in dogs with spirocercosis and showed promise as a cost-effective and safe initial diagnostic procedure for further evaluation and characterization of suspected caudal esophageal lesions.

Pressures were measured with miniature transducers positioned within the gastric lumen of six young pigs, 20–40 kg, eating and drinking operantly. The pigs were free to move about, lie down, sleep, eat, and drink without disturbance. 1) At the end of 4–5-h fasts (with no drinking), mean pressure within the stomach was 12 cm H 2 O, then rose during 22-min eating bouts to 22 cm H 2 O. 2) At the end of 16–18-h periods of food and water deprivation, intragastric pressure was 9 cm H 2 O. When water was drunk, pressures rose only to 13 cm H 2 O, then fell. When food was then eaten, pressures rose during 29-min meals to 22 cm H 2 O. 3) During spontaneous eating and drinking, intermeal pressures were maintained at 22–25 cm H 2 O, fell by 4–5 cm H 2 O just as eating or drinking began, then rose slowly, but only to the preingestive pressure level by the end of the bout. These results indicate that during spontaneous eating and drinking, gastric distention per se plays a smaller direct role in causing satiety than it does during meals ingested after a period of food deprivation.

We describe the use of an endoscopy face mask with a perforated membrane, which allows a nasogastric tube for continuous noninvasive ventilation in acute hypercapnic respiratory failure, in 2 patients who developed gastric distention. This interface was able to avoid most nonintentional leaks through the mask, as compared with a conventional approach, improving ventilation efficiency. To our knowledge, this is the first case report of an endoscopy face mask used in noninvasive ventilation for this specific side effect.

The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess of gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined. Numerous treatment modalities have been tried but with questionable success. Valproate has proven effective in two trials investigating persistent non-surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided.

In this study, we investigated the role of gastric distention with additional water to determine whether it is beneficial for the differentiation of locally advanced gastric carcinomas from physiological 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the stomach and to characterize the FDG uptake of gastric carcinomas by relating it to the histopathological properties of the tumours.Sixteen patients with locally advanced gastric carcinomas and 20 control patients were studied by FDG-PET. After whole-body PET imaging, the patients drank 400 ml of water and then spot imaging with additional water of the stomach was performed. The final diagnosis was determined from the results of surgery. The gastric areas were divided into the upper, middle, and lower parts. The degree of FDG uptake in the stomach was qualitatively evaluated by visual grading into three degrees. For quantitative analysis, the regional tumour uptake was measured by mean standardized uptake values using a region of interest technique.In visual analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET without additional water ingestion were 100, 50, 62, 100 and 72%, respectively, and those of PET with additional water ingestion were 88, 100, 100, 91 and 94%, respectively. Using spot imaging under the condition with additional water ingestion, four gastric carcinomas were depicted more clearly.Gastric distention as a result of patients drinking a glass of water is a simple and noninvasive method for improving the diagnostic accuracy of FDG-PET in patients with locally advanced gastric carcinoma.

Functional dyspepsia (FD) is a highly prevalent and heterogeneous disorder. Although recent studies have investigated various pathophysiological mechanisms, the pathogenesis of FD remains obscure. Pathophysiological mechanisms currently proposed to be involved in FD symptom generation include delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distention, altered duodenal sensitivity to lipids or acid, abnormal duodenojejunal motility, and others. Pathogenetic factors implicated in the occurrence of FD include genetic susceptibility, Helicobacter pylori status, acute gastrointestinal infections and psychosocial factors. The present article provides an overview of pathogenetic factors, pathophysiologic mechanisms and their potential roles in FD.